A Comparative Study between External Fixation Versus Locking Compression Plate in Managemento Extra Articular Proximal 1/3 Tibia Fractures

BackgroundFractures occurring in the proximal tibia of extra articular type often results from high-energy trauma with comminution and displacement problems.Most authorities agree that operative management of these fractures is best option in order to optimize patient outcomes.We want to assess which treatment method would be a best option for the patient with less complications and quicker recovery.Objective To evaluate the effects of external fixation and LCP techniques in the management of extra-articular proximal third tibial fractures in terms of bone union time, infection, postoperative complications, operative time, bleeding and cost effectiveness of both techniques. Materials and MethodsThe study was carried out on 40 patients with proximal third tibia fractures of AO classification type 41 A2 (transverse metaphyseal) and 41 A3 (comminuted metaphyseal) who received surgical treatment at the orthopedic units of the first affiliated hospital of Jiamusi university, between December-2014 to March-2016.The subjects of the study were patients aging between 35~45 years old, 22 male and 18 female .Patients were divided into 2 groups depending on the surgical treatment received ; observation group comprised of 20 patients treated by external fixation and the control group comprised of 20 patients treated by Open reduction internal fixation with locking compression plate.Pathological fractures, fractures due to malignancy were excluded from the study.Clinical and radiological follow-up was performed at one month, 2 months, 3 months, 6months and 12 months post operatively for both groups.Patients were systematically assessed for knee function, post operative infections, healing time, intra operative bleeding and surgical time, state of reduction after one week.Knee function was graded using Rasmussen Knee score.Clinical data was summarized and a data base established after which SPSS18.0 software was used to choose the appropriate statistical analysis method and conclusions were obtained.Results 32 patients showed up for post operation checkup after one-month, 2-months,3-months ,6-months, after 1 year 20 patients showed up .At one week post op , radiological assessment showed that 18-patients (93%) got anatomical reduction in LCP group as compared to 16-patients (80%) in the external fixation group.Average duration of bone union in external fixation was 14-weeks and that in LCP group 16-weeks.2 cases in the external fixation group had pin tract infection, which were resolved with administration of antibiotics and local pin site care; no infection was noted in the LCP group.There were 2 cases of delayed union in LCP group and these were re operated using locking plates and auto bone grafts.No deep venous thrombosis, pneumonia or bed sores developed in any group patients.There was one case of bed sore in LCP group.There was initial knee stiffness in EF group and mean knee range of motion was 122 degree and that in LCP group as 126 degree.Continuous passive motion was started as soon as the pain subsided.After 2-months and 6-months follow ups, no radiographic signs of osteoarthritis detected.Mean Rasmussen knee score was good 25 in EF group patients and good 24.5 in LCP group.Mean weight bearing time was 13-weeks post operatively for both groups.No cases of compartment syndrome detected in both groups.Checkup after 1-year of both group patients, all were full weight bearing with satisfactory range of motion.